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1 USMLE Step 2 -- DEDICATED !!! > Set 4 > Flashcards

Set 4 Flashcards

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USMLE® Step 1 flashcards
1
Q

Oligohydramnios is when the single deepest pocket is less than ______

A

< 2cm

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2
Q

How to manage acute bleeding in vWF deficiency.

A

Desmopressin

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3
Q

What 3 tests are used to diagnose vWF deficiency.

A

1) vWF antigen level
2) Factor VIII level
3) vWF activity (ristocetin cofactor activity)

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4
Q

Borderline personality disorder best form of psychotherapy.

A

Dialectical behavior therapy

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5
Q

Antipsychotic extrapyramidal effect: Acute Dystonia
Symptoms?
Tx?

A

Acute Dystonia Symptoms = Sudden sustained contraction of eyes, neck, mouth, tongue
Tx = Benztropine, Diphenhydramine

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6
Q

Antipsychotic extrapyramidal effect: Akathisia
Symptoms?
Tx?

A

Akathisia symptoms = restlessness, inability to sit still

Tx = Beta blocker, Benzodiazepine, Benztropine

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7
Q

Antipsychotic extrapyramidal effect: Parkinsonism
Symptoms?
Tx?

A

Parkinsonism symptoms = Tremor, rigidity, bradykinesia

Tx = Benztropine, Amantadine

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8
Q

Antipsychotic extrapyramidal effect: Tardive dyskinesia
Symptoms?
Tx?

A

Tardive Dyskinesia symptoms = Dyskinesia of mouth, face, trunk and extremities (after > 6 month of therapy)
Tx = Valbenazine, Deutetrabenazine

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9
Q

Nausea, vomiting and early satiety in a type 2 diabetic. Dx? Tx?

A 
Dx = Diabetic autonomic  neuropathy of the GI tract results in delayed gastric emptying
Tx = Metaclopramide (a prokinetic agent)
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10
Q

What is the NEXT STEP if neonate has billous emesis and X-ray shows dilated loops of bowel.

A

NEXT step: contrast enema to differentiate between Meconium Illeus and Hirschsprung’s Disease.

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11
Q

Treatment of Meconium ileus

A

Hyperosmolar enema (Gastrografin) to break up the inspissated meconium

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12
Q

Compare and contrast 5-alpha-reductase deficiency and Androgen insensitivity syndrome?

A

Both 5-Alpha-Reductase Deficiency and Androgen Insensitivity Syndrome present as females with male internal genetelia (testes).
The difference is that patients with Androgen Insensitivity Syndrome will develop breasts. 5-Alpha-Reductase Deficiency patient will not.
At puberty patients with 5-Alpha-Reductase Deficiency will develop Clitoromegaly.

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13
Q

At what gestational age to test for Anti-D immune globulin?

A

28-32 wks

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14
Q

At what gestational age to test for Group B Strep?

A

35 - 37 wks (test is valid for 5 wks)

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15
Q

If suspecting an ectopic pregnancy but transvaginal ultrasound is negative then what is the next step in management.

A

Serial beta-HCG – repeating every 2 days until beta-HCG is more than 1500. Then repeat transvaginal ultrasound.
(if beta-HCG is trending down then this is a miscarriage)

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16
Q

Best test to diagnose Bronchiectasis.

A

HIGH RESOLUTION CT

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17
Q

Loss of urine when lifting. What type of urinary incontinence is this? Treatment?

A

Stress Urinary Incontinence

Tx = Kegal exercises

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18
Q

Sudden urge to void followed by immediate loss of urine. What type of urinary incontinence is this? Treatment?

A

Urgency Incontinence

Tx = anticholinergics and timed voiding

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19
Q

Edema and narrowing of the proximal trachea. Dx?

A

Dx = Croup (laryngeotracheitis)

-> this is why you get the steeple sign

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20
Q

Edema of the epiglotis and aryepiglotic folds. Dx?

A

Epiglottitis (Haemophilus influenzae b)

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21
Q

Laryngeotracheitis. Tx?

A

Laryngeotracheitis = Croup
Tx = corticosteroids (dexamethasone) to decrease airway edema
If severe then Tx = nebulized epinephrine

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22
Q

Persistent patent processus vaginalis. Dx?

A

Hydrocele

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23
Q

Back pain in a patient in 20s and 30s. What diagnosis to suspect? Best test to establish diagnosis?

A

Dx to suspect = Ankylosing spondylitis

Test = X-ray of the sacroiliac joints

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24
Q

3 step mechanism of diabetic nephropathy.

A

1) Glomerular Hyperfiltration
2) Thickening of glomerular basement membrane
3) Nodular sclerosis

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25
Q

In constrictive pericarditis – what do you see on jugular venous pulse tracing?

A

Prominent x and y descent

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26
Q

When to use unsynchronized cardioversion.

A

Ventricular fibrilation

Pulseless ventricular tachycardia

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27
Q

Why may PT be elevated in exertional heat stroke?

A

because exertional heat stroke can cause DIC

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28
Q

Acute right upper quadrant pain in an alcoholic patient.

A

Alcoholic hepatitis

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29
Q

Staghorn calculi in the kidneys are caused by what organisms.

A

Urease-producing organisms (Proteus, Klebsiela)

NOT E. coli

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30
Q

Loss of maternal copy of 15q11-q13. Dx?

A

Angelman

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31
Q

Loss of paternal copy of 15q11-q13. Dx?

A

Prader-Willi

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32
Q

Disregulation of imprinted gene expression on chromosome 11p15. Dx? Key Symptoms?

A

Dx = Beckwith-Wiedemann syndrome

Key symptoms = Hemihyperplasia, umbilical hernia / omphalocele

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33
Q

Nondisjunction resulting in an extra X chromosome. Dx? Key symptoms?

A

XXY = Kleinfelter

Key symptoms = small testes, tall stature

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34
Q

X-linked mutation of the fragile X mental retardation 1 gene. Dx? Key symtpoms?

A

Dx = Fragile X

Key symptoms = large testes, prominent forehead

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35
Q

X-linked mutation of the hypoxanthine-guanin phosphoribosyl transferase gene. Dx? Key somptoms?

A

Dx = Lesch-Nyhan

Key symptoms = hyperuricemia, self-mutilation

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36
Q

Enlargement of submandibular glands. Dx? Causes?

A 
Dx = sialadenitis
Causes = liver disease (alcoholic or non-alcoholic), malnutrition (diabetes, bulimia)
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37
Q

3 Symptoms of Vit A deficiency

A
  • Impaired night vision
  • Dry eye
  • Keratinezation of conjunctiva and cornea
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38
Q

Size of endometrial stripe that makes you suspect malignant proliferation of the endometrium.

A

> 4 mm

39
Q

What vaginal pH helps to confirm menopause and why?

A

Vaginal pH > 5 suggests menopause

Low estrogen -> low glycogen -> low vaginal lactobacilli activity -> less acid, higher pH

40
Q

Panic disorder treatment

A

Primary: SSRI/SNRI + CBT
Acutely: Benzodiazepines

41
Q

What psychiatric condition is treated with beta blockers?

A

Performance anxiety

42
Q

What is the most significant risk factor for preterm labor?

A

Previous preterm labor

43
Q

Fasting serum gastrin level is a test used to diagnose what condition?

A

Dx = Gastrinoma (Zollinger-Ellison syndrome)

gastrin level > 1000 pg/mL

44
Q

What are the endoscopic findings associated with Gastrinoma (Zollinger-Ellison syndrome)

A
  • prominent gastric folds

- ulcers in multiple areas in GI

45
Q

Glucocorticoid-induced myopathy.

Normal or high ESR, CK?

A

Normal ESR

Normal CK

46
Q

Polymyalgia rheumatica.

Normal or high ESR, CK?

A

High ESR

Normal CK

47
Q 
Inflammatory myopathy (polymyositis, dermatomyositis).
Normal or high ESR, CK?
A

High ESR

High CK

48
Q

Statin-induced myopathy.

Normal or high ESR, CK?

A

Normal ESR

High CK

49
Q

Hypothyroid myopathy.

Normal or high ESR, CK?

A

Normal ESR

High CK

50
Q

Metabolic abnormalities that can be caused by hypothyroidism.

A

Hyperlipidemia

Hyponatremia

51
Q

What are non-thyroid lab findings that are found in Hypothyroidism?

A

High Lipids
High Creatinine Kinase
High Serum Transaminases

Low Sodium

52
Q

Clicking sensation and a burning pain when the 3rd and 4th metatarsal heads are squeezed together. Dx? Mechanism?

A 
Dx = Morton Neuroma
Mechanism = Neuropathic degeneration of the interdigital nerves
53
Q

Urinanalysis in ethylene glycol poisoning

A

Envolope-shaped calcium oxalate crystals

54
Q

Mechanism of the following side-effect of glucocorticoids: leukocytosis

A

Glucocorticoids cause mobilization of marginated neutrophils into the bloodstream.

55
Q

Dextromethorphan. Use? Side effect?

A

Use = Antitussive
Side effect =
- mild abuse potential (it is a codeine analogue)
- may cause seratonin syndrome if combined with other meds
- false negative drug screen for PCP

56
Q

Penetrating injury to one eye, later develops into damage of the other eye. Dx? Mechanism?

A 
Dx = Sympathetic ophthalmia
Mechanism = Immunologic mechanism involving the recognition of "hidden" antigens
57
Q

Patient with pneumocystis pneumonia. Tx?

A 
Tx = TMP-SMX
\+/- corticosteroids
Give corticosteroids IF:
PaO2 < 70
Alveolar-arterial ratio >35
58
Q

Mechanism of hepatic hydrothorax.

A

Alcoholic develops hydrothorax due to low albumin levels. Hepatic hydrothorax results in transudative pleural effusions that pass through defectc in the diaphragm.

59
Q

Give GBS prophylaxis if rupture of membrane is longer than _____

A

18 hrs

60
Q

Cyclosporine (immunosuppresant) side effects

A 
Nephrotoxicity
Hyperkalemia
Hypertension
Tremor
Gum Hypertrophy
Hirsutism
61
Q

Tacrolimus (immunosuppresant) side effects

A 
Nephrotoxicity
Hyperkalemia
Hypertension
Tremor
NO gum hypertrophy
NO hirsutism
62
Q

Azathioprine (immunosuppresant) side effects

A

Diarrhea
Leukopenia
Hepatotoxicity

63
Q

Mycophenolate (immunosuppresant) side effects

A

Bone marrow suppression

64
Q

Most common cause of syncope after MI.

A

Reentrant ventricular arrhythmia

65
Q

If a varicocele fails to reduce in the recumbent position then this should suggest what diagnosis?

A

Renal cell carcinoma

66
Q

Most sensitive and specific test to diagnose renal cell carcinoma.

A

CT scan of abdomen

67
Q

Most common cause of proteinuria in Hep B infected individual.

A

Membranous nephropathy

68
Q

Chlamydial conjunctivitis timetable for neonates.
vs
Gonococcal conjunctivitis timetable

A

Chlamydial conjunctivitis presents 5-14 days after birth.

Gonococcal conjunctivitis presents within the 1st week of life.

69
Q

Chlamydial conjunctivitis treatment?

A

Oral Azithromycin

70
Q

What is the treatment for Strep mutans infective endocarditis if the organism is susceptible to penicillin.

A

IV penicillin G
or
IV ceftriaxone

71
Q

What are the target blood glucose levels for patients with gestational diabetes? Fasting, 1 hr and 2 hr postprandial

A

Fasting < 95
1 hr postprandial < 140
2 hr postprandial < 120

72
Q

Treatment for postpartum endometritis

A

Clindamycin + Gentamycin

73
Q

For prerenal acute kidney injury what is the BUN/CR, Urine sodium, Fractional excretion of sodium.

A

BUN/CR > 20
Urine sodium < 10
Fractional excretion of sodium < 1%

74
Q

For intrarenal acute kidney injury what is the BUN/CR, Urine sodium, Fractional excretion of sodium

A

BUN/CR < 10
Urine sodium > 20
Fractional excretion of sodium > 1%

75
Q

What are the 3 auscultory findings for aortic stenosis?

A

1) Diminished and delayed carotid pulses
(“pulses parvus et tardus”)
2) soft and single s2
3) Systolic murmur.
a) If aortic stenosis is mild then the systolic murmur is: early peaking
b) If aortic stenosis is severe then the systolic murmur is: Late-peaking crescendo-decrescendo

76
Q

Apical mid-diastolic murmur. Dx?

A

Mitral stenosis

heard after opening snap

77
Q

What chronic valvular defects can cause S3 and S4.

A 
S3 = chronic mitral or aortic regurgitation
S4 = chronic aortic stenosis
78
Q

Loud S1. Dx?

A

Mitral stenosis

79
Q

2 conditions associated with acanthosis nigricans.

A

1) insulin resistance

2) gastrointestinal malignancy

80
Q

What is associated with the following skin condition? Porphyra cutanea tarda

A

Hep C

81
Q

What is associated with the following skin condition?

Dermatitis herpetiformis

A

Celiac disease

82
Q

What is associated with the following skin condition?

Psoriasis

A

HIV and Streptococcal pharyngitis

83
Q

What is associated with the following skin condition?

Severe seborrheic dermatitis

A

HIV and Parkinson’s disease

84
Q

What is associated with the following condition?

Explosive onset of multiple itchy, seborrheic keratoses

A

Gastrointestinal malignancy

-> this is called Lesser-Trelat sign

85
Q

What is associated with the following condition?

Pyoderma gangrenosum

A

Inflammatory bowel disease

86
Q

Skin findings associated with Sarcoidosis

A 
Erythema nodosum (tender anterior tibial nodules)
and
Lupus pernio (violaceous facial papules or nodules)
87
Q

What 2 skin conditions are associated with Gastrointestinal malignancy?

A

1) Acanthosis nigricans (velvety thickening of skin in the neck or axillae)
2) Lesser-Trelat sign (explosive onset of numerous seborrheic keratoses)

88
Q

3 dermal signs associated with hepatitis C.

A

1) Porphyria cutanea tarda (blisters and scars, generally on sun-exposed areas)
2) Lichen planus (4Ps: purple, pruritic, polygonal papules/plaques)
3) Cryglobulinemic vasculitis (erythematous lower extremity papules or macules)

89
Q

What conditions are associated with the skin condition vitiligo (hypopigmentation due to the autoimmune destruction of melanocytes)?

A

Chronic lymphocytic thyroditis (Hashimoto)
and
Graves Disease

90
Q

What is the serum osmolarity and urine osmolarity in SIADH?

A

Serum osmolarity < 275

Urine osmolarity > 100

91
Q

Guideline for treatment of hyponatremia.

A

Na < 135: if asymptomatic or mild symptoms (lethargy, forgetfullness) – fluid restriction (<800 mL/day)

Na < 120 OR severe symptoms (seizure, coma) – hypertonic (3%) saline – correction must be < 8 mEq over first 24 hrs to avoid osmotic demyelination syndrome

92
Q

Most common cause of cor pulmonale.

A

COPD

93
Q

Compare and contrast cor pulmonale and cirrhosis.

A

Both Cor Pulmonale and Cirrhosis cause elevated JVP. In Cor pulmonale the liver is always enlarged, In Cirrhosis the liver in shrunken or fibrotic.

1 USMLE Step 2 -- DEDICATED !!! (4 decks)

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